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At least 19 recordsLinked to original sources
PubMed1975

Cardiorespiratory function during thoracic anaesthesia: a comparison of two-lung ventilation and one-lung ventilation with and without PEEP5.

Previous studies have shown that, in patients undergoing thoracic surgery, a relatively high positive end-expiratory pressure (PEEP of 10 cmH2O = PEEP10) has no beneficial effect on oxygenation during one-lung ventilation (OLV). In the present investigation, cardiorespiratory function was examined in 11 patients intubated endobronchially and undergoing thoracotomy. Comparison was made between two-lung ventilation (TLV) and OLV and between zero end-expiratory pressure and PEEP5 during OLV. Cardiac output was determined to obtain information of the total oxygen delivery (cardiac output times arterial O2 content. The change from TLV to OLV was accompanied by a marked fall in PaO2 and a marked rise in shunt, whereas no significant change was observed in mean cardiac output. Oxygen delivery also remained unchanged due to relatively small decrease in SaO2 (arterial oxygen saturation) and maintenance of cardiac output. The application of PEEP5 during OLV produced no significant changes in these parameters. The findings in individual patients demonstrated the relative importance of cardiac output in determining oxygen delivery during OLV. A significant negative correlation was found between inspiratory airway pressure and cardiac index during OLV.

Adult↗
PubMed2026

Effects of phenylephrine and norepinephrine with restrictive infusion on oxygenation during one-lung ventilation for lung surgery: a randomized controlled trial.

OBJECTIVE: This study compared&#xa0;the effects of norepinephrine or phenylephrine combined with restrictive infusion on the oxygenation during thoracoscopic one-lung ventilation (OLV). METHODS: Ninety patients were randomly divided into three groups: the norepinephrine group (Group N), the phenylephrine group (Group P), and the control group (Group C). Arterial partial pressure of oxygen (PaO2) and intrapulmonary shunt fraction (Qs/Qt) were measured with patients in lateral positions during two-lung ventilation (TLV) at 10&#x2009;min (T1), and during OLV at 15&#x2009;min (T2) and 45&#x2009;min (T3). Lung tissue samples were analyzed for endothelin and COX-2 levels after surgery. RESULTS: At T3, Group P had significantly higher PaO2 and lower Qs/Qt than Groups N and C (all p&#x2009;<&#x2009;0.05), with no significant differences between Groups N and C (all p&#x2009;>&#x2009;0.05). Compared to T1, Groups N and C showed significantly lower PaO2 and higher Qs/Qt at T2 and T3 (all p&#x2009;<&#x2009;0.05), with no significant differences in PaO2 and Qs/Qt at T3 compared with T2 (all p&#x2009;>&#x2009;0.05). Group P patients had lower PaO2 and higher Qs/Qt at T2 and T3 compared to T1 (all p&#x2009;<&#x2009;0.05), but at T3, PaO2 increased and Qs/Qt decreased compared to T2 (all p&#x2009;<&#x2009;0.05). Lung tissue levels of endothelin and COX-2 were significantly elevated in group P compared to groups N and C (all p&#x2009;<&#x2009;0.05). CONCLUSION: Combining phenylephrine with restrictive infusion during OLV improved oxygenation by increasing PaO2, decreasing Qs/Qt, and raising endothelin and COX-2 levels in lung tissue, thereby enhancing the HPV effect.

Humans↗
PubMed1992

The utility of a double-lumen tube for one-lung ventilation in a variety of noncardiac thoracic surgical procedures.

To determine the utility of one-lung ventilation (OLV) in a variety of noncardiac thoracic surgical procedures, 200 patients were studied to document the ease of double-lumen tube (DLT) placement, associated complications, intraoperative respiratory changes, and methods for managing hypoxic events. Most tubes could be placed, repositioned when necessary, and secured within 12 minutes. By defining tube position with fiberoptic bronchoscopy, auscultatory assessment of placement was found to be incorrect in 38.0% of patients. The tip occluded the respective upper lobe orifice in 40.5% of this subgroup, the endobronchial cuff was at or above the carina in 38.7%, and in the wrong mainstem bronchus in 20.8%. During OLV, PaO2 initially fell to approximately 200 mmHg in most patients but gradually rose during the balance of the operation. Hypoxia (PaO2 less than 80 mmHg) during OLV developed in 28.5% of patients. Preoperative spirometry and arterial blood gases had no predictive value for this complication. Pulse oximetry values between 95% and 100% reliably reflected systemic arterial oxygen saturation. Hypoxia occurring during OLV was successfully reversed in 40.0% of instances by positive end-expiratory pressure (PEEP) to the ventilated lung. The addition of continuous positive airway pressure (CPAP) to the nonventilated lung reversed persistent hypoxia in virtually all cases. There was no difference in oxygenation, carbon dioxide elimination, airway pressures, or intraoperative complications noted between right and left double-lumen tubes. In conclusion, a DLT for OLV can expeditiously and safely be placed. Because auscultation for tube position is unreliable, bronchoscopic assessment of final position should be performed in every instance. Hypoxia during OLV can be detected reliably by pulse oximetry.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Experimental and clinical study of cardiopulmonary hemodynamics under one-lung ventilation during transthoracic esophagectomy].

Cardiopulmonary hemodynamics in pre- and postoperative period after transthoracic esophagectomy under one-lung ventilation (OLV) was investigated in experimental and clinical studies. In experimental study, 30 mongrel dogs were assigned to one of the groups: Group 1 (n = 10): 2 hour right thoracotomy alone under one (n = 5)- or two-lung ventilation (TLV) (n = 5), Group 2 (n = 10): thoracotomy + esophagectomy, Group 3 (n = 10): esophagectomy + right thoracic vagotomy. For further evaluation of the effect of vagotomy on increase of extravascular lung water (EVLW) on 3rd POD, the following 2 groups were designed as Group 4-1) (n = 5): thoracotomy + right thoracic vagotomy and Group 4-3) (n = 5): esophagectomy + left thoracic vagotomy. In clinical study, 30 patients underwent transthoracic esophagectomy were randomly divided into either OLV or TLV group. Cardiopulmonary hemodynamics and postoperative complications were investigated in pre- and up to 3 POD. 1. Cardiopulmonary parameters and EVLW except PaO2 and shunt ratio were not different between OLV and TLW groups in experimental study. PaO2 of OLV group dropped from the pre-thoracotomy value of 577 +/- 75 mmHg to 98 +/- 47 mmHg. This decrease was significant in comparison with TLV (582 +/- 85 mmHg to 215 +/- 132 mmHg) (p less than 0.05). Shunt ratio increased in the OLV group from 10 +/- 11% to 37 +/- 13%. This increase was also significant in comparison with TLV (24 +/- 10% from 9 +/- 9%) (p less than 0.05). However, both PaO2 and shunt ratio returned to the pre-thoracotomy value after stopping of OLV and showed no difference compared with TLV. 2. EVLW per kg was not different between 5 groups. Values of right to left lung ratio of EVLW in Group 3 and Group 4-3), 1.77 +/- 0.26 and 1.82 +/- 0.26, were greater than that in Group 1, 1.39 +/- 0.17 (p less than 0.05). This difference seems to be caused by increase of permeability of pulmonary capillaries. 3. Cardiopulmonary parameters and postoperative complications were not different between OLV and TLV groups in clinical study. In conclusion, OLV is a desirable procedure, not only for good exposure of the operative filed, but also for its safety regarding the cardiopulmonary hemodynamics. Transthoracic esophagectomy plus vagal branch denervation, which is necessary for aggressive lymphadenectomy around the trachea, increases EVLW and subsequent pulmonary edema compared with thoracotomy alone.

Aged↗
PubMed1976

Influence of tidal volume and pulmonary artery occlusion on arterial oxygenation during endobronchial anesthesia.

Arterial blood gases, intrapulmonary right-to-left shunt, airway pressures, and systemic and pulmonary arterial pressures were studied in 20 patients ventilated through a double lumen endobronchial tube during thoracotomy. Inspired oxygen concentration was 98% to 100%. Blood samples for measurement of blood gases and oxygen content were obtained during ventilation of both lungs (VT 15 ml/kg), one lung (VT 15 ml/kg and 8 ml/kg), and after occlusion of the opposite pulmonary artery. Mean oxygen tensions fell significantly, from 310 mm Hg during two-lung ventilation to 155 during one-lung ventilation, and rose again to 280 after pulmonary artery occlusion. Corresponding mean shunt values rose from 25% to 34% of cardiac output and fell again to 25%. When VT was reduced, patients who had had low oxygen tensions (less than 150 mm Hg) at the higher volume showed an increase in PaO2, and conversely. Shunts changed accordingly. Even with this high FIO2, some patients had oxygen tensions of less than 80 mm Hg during lung collapse. PaO2 values during one-lung ventilation were significantly related to patients' preoperative oxygen tensions, as well as to those during two-lung ventilation. In view of the low arterial oxygen tensions found in some patients and the lack of absolute correlation of the PaO2 with tidal volume, an FIO2 of close to 1.0 is recommended during one-lung ventilation, along with frequent or continuous monitoring of the arterial PaO2.

Anesthesia, Inhalation↗
PubMed1992

Operative lung constant positive airway pressure with the Univent bronchial blocker tube.

Constant positive airway pressure (CPAP) to the operative lung during one-lung ventilation (1-LV) with a double-lumen tube increases PaO2; there have been no reports of application of CPAP to the operative lung during 1-LV with the Univent bronchial blocker (BB) tube. This study determined the method of administration and the effect on PaO2 of 10 cm H2O of CPAP to the operative lung during 1-LV (1-LV + 10 CPAP) produced by the Univent BB system. We designed our CPAP system for the Univent BB using an in vitro lung model so that low O2 flow rates (2-4 L/min) yielded clinically relevant levels of CPAP (5-20 cm H2O) over a wide range of lung compliance. The CPAP system simply consisted of placing a resistance to a variable oxygen flow distal to the operative lung. Seven consenting patients who required thoracotomy and 1-LV were anesthetized and their tracheas were intubated with the Univent BB tube; the BB was inserted into the appropriate mainstem bronchus until the proximal surface of the BB cuff was just distal to the tracheal carina. PaO2 was measured in the seven patients during 12 sequences of two-lung ventilation (2-LV), one-lung ventilation (1-LV), and 1-LV with 10 cm H2O CPAP (1-LV + 10 CPAP). 1-LV + 10 CPAP was always instituted on the deflation phase of a previous single tidal inhalation. We found in our patients with a lung compliance of 32 +/- 4 mL/cm H2O that 2.4 +/- 0.2 L/min of oxygen flow produced 1-LV + 10 CPAP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Continuous noninvasive blood pressure monitoring during thoracic surgery.

To evaluate the usefulness of noninvasive blood pressure monitoring during thoracic surgery, blood pressure measurements obtained with the Finapres 2300 (Ohmeda, Boulder, CO) were compared with an intraarterial catheter system in 10 patients undergoing thoracotomy for lobectomy or pneumonectomy. The Finapres measurements were compared with pressure data obtained ipsilaterally from a radial artery catheter-transducer system. The waveforms were recorded using a strip chart recorder; the systolic (SBP) and diastolic blood pressures (DBP) were measured every 20 seconds on the paper trace. Precision and bias were calculated for SBP and DBP for each patient and for the pooled data, with the invasive blood pressure being considered the gold standard. A total of 1,861 measurement pairs were recorded, 938 pairs during one-lung ventilation. The Finapres underestimated SBP during two-lung ventilation, and overestimated SBP during one-lung ventilation. The precision was good and the biases were small, but there were wide individual variations. It is concluded that the Finapres can be useful in estimating the variability and following the trends of radial arterial blood pressure during thoracic surgery, and is an acceptable alternative to invasive blood pressure monitoring.

Aged↗
PubMed1992

Anaesthesia for a patient undergoing transthoracic endoscopic vagotomy.

We describe the anaesthetic management of a patient who underwent transthoracic endoscopic vagotomy. One-lung ventilation was necessary to provide adequate surgical access. Potential intraoperative problems involved arterial oxygen saturation during one-lung ventilation, unequal intrathoracic pressures causing mediastinal displacement and inadvertent myocardial injury by surgical instruments and diathermy. The management of these problems and the benefits of endoscopic surgery to the patient are discussed.

Anesthesia, General↗
PubMed2026

Effect of protective ventilation throughout the intubation period on perioperative oxygenation in patients undergoing MIDCABG: a randomised controlled trial.

INTRODUCTION: Minimally invasive direct coronary artery bypass grafting (MIDCABG) requires prolonged one-lung ventilation (OLV), increasing postoperative pulmonary complications (PPCs) risk. We investigated whether protective lung ventilation (PLV) throughout intubation benefits MIDCABG patients. METHODS: In this single-center randomized study, MIDCABG patients received PLV (low tidal volume of 6-8&#x2009;mL&#xb7;kg-1, PEEP of 6&#x2009;cm H2O, alveolar recruitment maneuvers) or conventional mechanical ventilation (CMV, tidal volume of 8-10&#x2009;mL&#xb7;kg-1, without PEEP or maneuvers) from tracheal intubation to extubation. The primary outcome was perioperative oxygenation, assessed by the PaO2/FiO2 ratio. RESULTS: Sixty patients (n = 30 per group) were enrolled. Compared with CMV, PLV improved PaO2/FiO2 ratios (mean difference at OLV60: 34.56&#x2009;mmHg; 95% CI: 11.78-57.33; p&#x2009;<&#x2009;0.01), shortened median durations of postoperative mechanical ventilation (median difference: -4.5&#x2009;h, 95% CI: -8.5 to -0.5; p&#x2009;=&#x2009;0.013) and hospital stay (median difference: -3.0&#x2009;days, 95% CI: -5.0 to -1.0; p&#x2009;=&#x2009;0.019). PLV also reduced driving pressure, airway pressure and intrapulmonary shunt during OLV (all p&#x2009;<&#x2009;0.05). Desaturation occurred in 23.3% of CMV patients and 13.3% of PLV patients (p&#x2009;=&#x2009;0.506). Hemodynamic parameters were generally comparable between groups, except for lower MPAP and PVRI in the PLV group during OLV and after ICU admission (p&#x2009;<&#x2009;0.05). The incidence of PPCs did not differ between groups. CONCLUSIONS: In patients undergoing MIDCABG, PLV applied throughout intubation improved perioperative oxygenation and shortened the duration of postoperative mechanical ventilation and hospital stay, but did not reduce PPCs. CLINICAL TRIAL REGISTRATION: ChiCTR1900022005.

Humans↗
PubMed1992

Laser endoscopic sympathectomy for palmar hyperhidrosis.

Hyperhidrosis palmaris is a common disorder among the Orientals. Despite numerous therapeutic modalities in practice, none has proved entirely satisfactory. With the introduction of video-endoscopic surgery, we combined this system with a fiber optic Nd-YAG laser unit, electrocautery, and a laser Doppler flowmeter to design a new and promising therapeutic technique for palmar hyperhidrosis. General anesthesia with alternating one-lung ventilation is essential for a safe and smooth endoscopic sympathectomy. An operating endoscope was introduced into thoracic cavity via the second intercostal space and then attached to a CCD camera video system, which provided clear visibility of the sympathetic trunk in most cases. The proper level of the sympathetic trunk was further confirmed with the aid of vasomotor response of the palmar skin resulting from electric stimulation on the related sympathetic trunk. Finally, the confirmed target was precisely vaporized with a low power Nd-YAG laser through an endoscope. Twenty patients underwent bilateral sympathectomy, mostly on T2 and its adjacent trunk. This technique did not cause any injury to the lung or bleeding. No Horner's syndrome was produced. It provided a precise ganglionectomy on a confirmed target under clear magnified vision. Consequently, a definite and long-lasting therapeutic effect seemed warranted. It was considered to be a relative minor and safe procedure causing minimal discomfort and an almost invisible scar without producing serious complications. It also shortened the operation time and hospital stay remarkably in comparison with other open sympathectomy procedures.

Adolescent↗
PubMed1992

An experimental model for simultaneous quantitative analysis of pulmonary micro- and macrocirculation during unilateral hypoxia in vivo.

An experimental model was developed for quantitative analysis of pulmonary microcirculation using in vivo fluorescence videomicroscopy during unilateral hypoxia induced by one-lung ventilation (1 LV). In five white New Zealand rabbits, pulmonary arterioles on the surface of the right lung were visualized by means of intra-arterial injection of FITC-labeled erythrocytes and FITC-Dextran. During 1 LV of the left lung, the mean airway pressure in the right lung was kept at the level of two-lung ventilation (2 LV) by means of N2-CPAP. Arteriolar diameters as well as parameters of macrocirculation (AP, CVP, PAP, LAP, CO) and gas exchange (paO2, Qs/Qt) were measured simultaneously during 2 LV and 1 LV. FiO2 was kept constant at 1.0 during both experimental phases. Macrohemodynamic parameters during 1 LV did not differ from those measured during 2 LV. 1 LV induced a significant decrease in paO2 (213 +/- 105 versus 427 +/- 22 mm Hg, P < 0.05) and a significant increase in Qs/Qt (22 +/- 7 versus 13 +/- 2%, P < 0.05). During 2 LV (baseline), the pulmonary arteriolar diameters ranged from 15-120 microns. 1 LV resulted in a significant decrease of arteriolar diameters to 89.0 +/- 9.3% of baseline (P < 0.05). Relative changes in arteriolar diameters were similar for vessels with baseline diameters of 0-40, 40-60, and 60-120 microns (88.4 +/- 9.9%, 89.6 +/- 9.4%, and 88.4 +/- 8.7%, respectively). The present model is the first one allowing in-vivo investigation of HPV during 1 LV and 2 LV on the basis of simultaneous measurement of pulmonary arteriolar diameters and macrocirculatory parameters in vivo. Although PAP and PVR did not change significantly, a reduction of pulmonary arteriolar diameters was proven in response to alveolar hypoxia during 1 LV. We suggest the model to be useful in studying the physiological effects of HPV on macro- and microcirculation as well as investigating pathophysiological and pharmacological influences on HPV.

Animals↗
PubMed1992

Changes in PETCO2 and pulmonary blood flow after bronchial occlusion in dogs.

The use of PETCO2 in detecting accidental bronchial intubation was investigated. The PETCO2 was measured in six mongrel dogs after occluding the left mainstem bronchus in three conditions; pentobarbital anaesthesia, 0.8% halothane insufflation together with pentobarbital anaesthesia, and simultaneous left pulmonary artery and bronchial airway occlusion with intravenous pentobarbital anaesthesia. An external flow probe measured left pulmonary artery blood flow. The PETCO2 decreased after bronchial occlusion during pentobarbital (35 +/- 3 vs 30 +/- 5 mmHg) and halothane-pentobarbital (30 +/- 6 vs 25 +/- 6 mmHg) conditions (P less than 0.05). However, within three minutes of bronchial occlusion, the values of PETCO2 had returned to their pre-occlusion values. After five minutes of bronchial occlusion pulmonary artery blood flow in the non-ventilated lung decreased (P less than 0.05) during pentobarbital (770 +/- 533 ml.min-1 vs 575 +/- 306 ml.min-1) and halothane-pentobarbital (495 +/- 127 ml.min-1 vs 387 +/- 178 ml.min-1) conditions. Simultaneous bronchial and pulmonary artery occlusion prevented any changes in PETCO2. It was concluded that accidental one-lung ventilation results in small and transient decreases in PETCO2. A redistribution of blood flow from the non-ventilated to ventilated lung occurs which restores PETCO2 to the original values observed with two-lung ventilation.

Airway Obstruction↗
PubMed1978

Surgical management of massive hemoptysis. A ten-year experience.

Pulmonary bleeding was defined as massive when the collected blood was 600 ml or more in 24 hours. Hemoptysis of this magnitude carries more than 50% mortality when managed without surgical intervention, For this reason all patients admitted, bleeding massively, in the past ten years were considered candidates for surgical therapy. Localization of the bleeding was done by bronchoscopy. Pulmonary reserve was evaluated by clinical and radiological observation and, when feasible, by spirometry. Of the 75 patients seen with massive hemoptysis, 68 were operated. Seven patients were excluded for various reasons. Five of these patients died during the acute bleeding episode. Sixt-five resections were performed with 11 deaths (17%) and three cavernostomies with one death. Of 51 lobectomies, seven expired (14%). One segmentectomy survived. Other than the magnitude of the surgical resection, the mortality was related to the amount of bleeding in the 24 hours preceding the surgical procedure. Severe bleeding at the time of resection requiring one-lung ventilation also significantly influenced the mortality (33% against 7%). This experience shows that pulmonary resection is the treatment of choice in patients with massive hemoptysis.

Adolescent↗
PubMed1992

Video endoscopic sympathectomy using a fiberoptic CO2 laser to treat palmar hyperhidrosis.

Palmar hyperhidrosis is a common disorder among orientals. A new therapeutic technique for this disorder has been designed by combining a computer compact disc video endoscopic system with a fiberoptic CO2 surgical laser unit. The operation is performed under general anesthesia with alternating one-lung ventilation. There are three important aids in localizing the correct sympathetic segment: 1) direct visualization of its magnified image on the television monitor; 2) identification with an electrode probe palpation at its presumed location; and 3) monitoring the microvasomotor changes on the skin of the finger resulting from electrical stimulation of the sympathetic trunk. Subsequently, the confirmed sympathetic target is vaporized using a low power CO2 laser under direct vision on the television monitor. The laser is delivered to the target by a small optical fiber passing through a throacoscope, which is introduced into the thoracic cavity via the intercostal space between the second and third ribs at the midclavicular line. Fourteen palmar hyperhidrosis patients were successfully treated by this method. No complications, such as Horner's syndrome, bleeding, or intercostal neuralgia, were encountered. Although the number of cases treated was small, and the follow-up period was short, the evidence indicates that a definite sympathectomy on a confirmed segment under magnified vision is possible with this procedure, and could warrant a definite and long-lasting therapeutic effect. Based on our experience, the method is considered a relatively minor and safe procedure, causing minimal discomfort and almost invisible scars. The operation time and hospital stay were remarkably shortened in comparison with other conventional sympathectomy procedures.

Adolescent↗
PubMed1991

[Conservative surgical techniques in the area of lung surgery].

An important condition for careful operations in lung surgery are modern anesthesia procedures like one-lung ventilation and high-frequency jet ventilation. The aim of careful procedures is the preservation of normal lung tissue. Most commonly broncho- and angioplastic resections are performed to avoid a pneumonectomy without loss of radicality. Minimally invasive endoscopic surgical techniques combined with laser application complete the spectrum of careful procedures in thoracic surgery, e.g., for resection of lung cysts or for thoracic sympathectomy.

Humans↗
PubMed1992

Predicting arterial oxygenation during one-lung anaesthesia.

Eighty patients undergoing elective thoracotomy were studied to assess the possibility of predicting arterial oxygenation (PaO2) during one-lung anaesthesia (OLA). The first 50 patients were studied retrospectively. The method of multiple linear regression was used to construct a predictive equation for PaO2 during OLA. Potential predictors of PaO2 during OLA which were considered were: age, side of operation, preoperative pulmonary flow rates, preoperative and intraoperative PaO2 during two-lung ventilation. The three most significant predictors for PaO2 during OLA were: side right of operation (P < 0.05), preoperative FEV1% (P < 0.01) and intraoperative PaO2 during two-lung ventilation (P = 0.0001). The predictive equation for PaO2 after ten minutes of OLA was: PaO2 = 100 - 72 (side) - 1.86 (FEV1%) + 0.75 (two-lung) PaO2; (for side insert 0 for left-sided thoracotomy and 1 for right-sided thoracotomy). The remaining 30 patients were studied prospectively and the predicted PaO2 correlated with the observed PaO2 after ten minutes of OLA (r = 0.73, P < 0.01). Four of 30 patients had a predicted PaO2 at ten minutes of OLA < 150 mmHg. Of these, 2/4 subsequently required abandonment of OLA for pulse oximetric saturation < 85%. We conclude that although it is not possible to predict an individual patient's PaO2 during OLA with a high degree of accuracy, it is possible, before the initiation of OLA, to identify those patients whose arterial oxygenation is likely to decrease to low levels during OLA.

Aged↗